The present invention relates to an operating device provided with head restraining means connectible to an operating table, as well as with arm and hand supports, which enables the operating surgeon to perform the operation in a more efficient manner and, which can be successfully used during eye surgery, plastic surgery on the face, as well as in case of ear-nose-laryngological or nerve surgical procedures.
In the course of the development of the surgery and its associated sciences, ophthalmology has become a more and more extensively used operative procedure requiring more and more complicated and refined technique, such as microtechnique, and at the same time, it is associated with manual activities concentrated on a narrow operative field. In comparison with the other surgical areas, such operation is the most concentrated with respect to the activity and procedure involved. A single tiny movement, momentum or tremor may be determinative on the outcome of the process; the patient will be able to see, or becomes blind. The precise planning and execution of the immobility or micro-movements represent a serious task to be faced. The practice is, however, far behind. A study of the process in ophthalomological operations reveals that due to the lack of suitable clamping or immobilization, the patient is not likely capable for a steady co-operation to achieve immobility. Apart from the stress condition culminating from the situation, the incidental pain-reflex may also contribute to it, since pain-endurance in the final analysis is a matter of intelligence, therefore, particularly in the case of children, old people with declining health, an age-group where the number of ophthalmological interventions is higher, an even less reliable co-operation can be expected. (In certain types, or phases of incidental anaesthesia, the so-called "ancient" defensive reflexes may also arise through shutting out the consciousness.) Furthermore, the head of the patient is usually held by an assistant. Another factor which cannot be left out of consideration, is the hand of the operating surgeon: not every hand which is qualified for surgery is devoid of micromovements, tremors. Naturally these will become even more intensified physiologically in contrast to professional knowledge, and power of judgement which improve with age.
It can be frequently noticed during an operation, that in the critical moments the surgeon rests his hand, for example, against the forehead, nose, or breast of the patient or against the hand, etc. of his assistant. His attention is concentrated elsewhere, but performs alternative movements at the same time, so to say, requiring the subject of the present invention.
Apart from restraining the patient's head, fixing of his eyeball is also required, which is done with the so-called "stitching thread", since during operation the eye turns reflexively upwards, but this too is held by an unsupported human hand.
Thus relatively everything moves, in spite of the strict requirement for immobility.
More and more devices are available among the improving surgical aids, which are aimed at solving the above-described problems. The so-called pillory-type head support is used e.g., which is an annular extension and intends to prevent a passive or involuntary turn of the head to the side in some extent. This simple device, however, does not inhibit at all the active movement of the head, or the incidental reflex to sit up.
A similar device is describe in U.S. Pat. No. 4,019,727, which fixes the head not by an annular element only, but it also consists of a plate bent along a curve, the position of which is adjustable in relation to the base plate. The adjustment with such a device basically amounts to tipping, but the device does not allow for a complex adjustment and for a safe restraining or clamping.
A safer restraining becomes possible by the solution offered by U.S. Pat. No. 3,957,262. Here the head restraining device is a helmet-like elastic support, which can be fixed at varying height and angular positions. However, here the device functions also essentially with a two-point clamping, which as far as keeping an accurate position is not satisfactory and, it does not offer any aid for supporting the hand and arm of the surgeon performing the operation.
A safer restraining exists according to the solution described in U.S. Pat. No. 4,097,038, used in brain surgeries. Here the skull is held by a curved frame carried by a mechanism adjustable in several directions in such a fashion, that the cranial bone is fixed by a pin adjustable with a screw to a supporting element, the position of which is adjustable by a screw. The clamping is effected directly to the bone, thus it functions with a fairly rough intervention, which is unjustifiable in case of ear-nose-laryngological procedures. Apart from this, the clamping or anchorage here is based also on two-point support and, the hand of the surgeon is not supported at all.
A device described in Swiss Pat. No. 514,373 is used in nerve surgeries, which supports the head of the patient in case of procedures performed in a sitting position. In essence, the device is a U-shaped head support fitted with a complicated adjusting mechanism, which is practically useless for ophthalmological operations.
For the purpose of ophthalmological operations various semi-circular supports connectible to a table have already been produced for support of the arm onto which the surgeon rests his elbow. These, however, do not follow the two basic, but frequently changing positions of the ophthalmologist, who operates either from behind the head or from the side.
Such arm support is described, for example, in German Pat. No. 23 52 026. Here the arm supporting plates run on a circular rail, their movement is difficult and the spatial adjustment is practically not solved. Its fundamental shortcoming is that it supports the arm, not the hand, and in certain postures, or in operating positions, it inhibits rather than assists the task of the surgeon.
The most up-to-date operative microscopes attempt to meet the general demand for a support of the hand. Hinged, extendable extensions are fitted to the chair of the microscopes, which fix not only the arm but also the wrist joint as well, since in micro-surgeries, working only with finger movements is desirable. Naturally these can be used only in a sitting position, because of the frequent change in the posture.
Consequently, the hand becomes even more uncertain. Such hand supports enjoy a general acceptance in hand surgery, even that their adjustment is difficult, and dimensionally the adjustment possibility is very restricted.